Healthcare Provider Details

I. General information

NPI: 1225428907
Provider Name (Legal Business Name): NICHOLAS LAZZARO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2015
Last Update Date: 08/23/2021
Certification Date: 06/25/2021
Deactivation Date: 06/10/2021
Reactivation Date: 06/25/2021

III. Provider practice location address

424 E 34TH ST
NEW YORK NY
10016-4901
US

IV. Provider business mailing address

530 1ST AVE STE 9V
NEW YORK NY
10016-6402
US

V. Phone/Fax

Practice location:
  • Phone: 646-929-7800
  • Fax:
Mailing address:
  • Phone: 646-501-0197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number432110
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: